MY BEHAVIOURAL MANAGEMENT PLAN Name · 1 MY BEHAVIOURAL MANAGEMENT PLAN Name: CODES: BMP –...

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MY BEHAVIOURAL MANAGEMENT PLAN

Name:

CODES: BMP – Behavioural Management Plan; RPA – Restricted Practice, LR – Low Risk ; HR -High Risk

Date Commenced:

NDIS Behavioural Support Specialist:

How was the participant involved in the plan: Clinical interview and regular consultation was conducted to

identify personal interests, strengths, goals, behaviours of concern- from differing perspectives, triggers, past

interventions - helpful and unhelpful strategies, assessments administered to gain reliable information, client

involvement to ensure person-centred approach.

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Communication

My strengths, life dreams, and aspirations

Adaptable, independent, participates well, understands and follows routines, gentle, laughs along with

others, determined and inquisitive mind, motivated to improve mental health and wellbeing,

travel overseas, education and training, desire to improve confidence and resilience, increase independence

and engagement with leisure and community activities.

Likes/Dislikes

Likes: Outdoor, dancing, walks, food, going to the park, beach, swimming, toys, showering/bath, motorbikes,

soccer, Knights football team, Jurassic Park, Pokemon, listening to music, playing video games, Lego, going to

the movies.

Dislikes: unexplained change in routines. showering/bath, loud noises, people touching, fruit / vegetables,

being told what to do, being reprimanded as this causes anxiety, self-harm, feeling guilty of a wrongdoing,

being bullied and teases or witnessing this, rude peers.

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COMMUNICATION

Communicate verbally- YES /NO Communicates needs and wants using appropriate body language, facial expressions, behaviours and

vocalisations- YES/NO Use the key words to represent a request YES/NO Understands what people say YES/NO

Prefers familiar phrases OR short and clear instructions YES/NO Prefers a maximum of two choices, but usually can only select or reject one at a time YES /NO

Benefits from short simple instructions and information YES/NO

Benefits from communication partner to modify other’s language to assist in understanding YES/NO

Benefits from person to assist in recognizing another’s perspective and in interpretation of their behaviour

YES/NO

EXAMPLES: severe receptive and expressive language abilities, and social communication skills – along with ASD

diagnosis complicates communication- impacts on ability to understand verbally presented information and

find the words and formulate sentences reciprocate. Difficulties with social communication skills: initiating and

maintaining a conversation, responding appropriately to others and interpreting the nonverbal behaviours of

others.

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Relevant History

SOCIAL AND EMOTIONAL WELLBEING

Happy: big smile, giggling, calm, relaxed, rocking gently, taking staff hands Sad/Flat: withdrawn, quiet, seeking support

Elevated: vocalising, grunting, refusing to follow requests, biting hand/fist, rocking back and forth with increasing

speed

Angry : Grabbing others, pinching, pulling others’ hair, biting down on the back of his hand, slapping his head,

vocalising loudly, flipping/pushing furniture

Emotionally Dysregulated: explosive, tantrums, moody, results in volatile relationships

Supports: family, extended family, friendships, community, recreational groups YES/NO

Sensitive to unpredictable and/or negative behaviours YES/NO

EXAMPLES: struggles managing conflict- dislikes confrontation, prefers online communication platforms,

experiences anxiety and persistent symptoms of depression, presents with low self-esteem and poor resilience,

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Relevant History continued

RELEVANT INFORMATION

Current Diagnosis:

Personality: passive/gently nature/sensitive/fragile/laughing/argumentative/ self-critical,

low tolerance, easily agitated, sensitive/ happy/ prefers own space/ unpredictable

Developmental issues/Stature:

Health Issues:

Education/Schooling:

Family Circumstances: siblings, parents, attachments, extended family

Social Life/Friendships/Relationships

Current Living: family home, group home/residential

Current activities: daily programs, working, school, tertiary education, sport, exercise,

recreational

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Current Interventions:

Trauma: abuse and/or neglect

Reportable Incidents/Complaints/Suspensions:

ABC data collection:

Behaviours of concern

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Personality: passive/gently nature/sensitive/fragile/laughing/argumentative/ self-critical, low tolerance, easily

agitated, sensitive

Developmental issues:

Interventions:

Trauma: abuse and/or neglect

Family Circumstances: siblings, parents, attachment, extended family

Current Living: family home, group home/residential

Current activities: daily programs, working, school, tertiary education, sport, exercise, recreational

Behaviours of concern

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Sensory Processing and Emotional Regulation

Example:.

• Has significant differences in the way processing sensory information YES/NO

• Low registration of certain type of sensory stimulation (needs greater intensity of stimulation for nervous system to register) YES/NO

• Auditory processing - Over-responsive to noise- needs warnings of unexpected stimuli YES/NO

• Visual processing - impact of glare on visual sensitivity severe YES/NO

• Tactile processing - avoids markers, glue, shoes, certain textures YES/NO

• Oral sensory processing - food sensitivities, avoids brushing teeth YES/NO

• Movement processing - rocks, paces, fidgets YES/NO

• Classroom adaptation difficult due to sensory processing differences YES/NO

• Presents with arousal, avoidance, stimulus seeking behaviours YES/NO

• Avoids crowds- shops, community settings YES/NO

• Experiences emotional outbursts YES/NO

• Evidence of avoidance behaviours YES/NO

• Non- compliance behaviours due to sensory issues YES/NO

• Sensitive to criticism from others – easily fixated on negativity YES/NO

• Highly emotional, mood swings evident YES/NO

• Actively seeks out activities that provide higher levels of vestibular and proprioceptive stimulation – eg, swing, moving vehicle, shower, lifting heavy furniture, biting hand YES/NO

• Struggles to regulate anxiety, depressive symptoms, frustration and anger YES/NO

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Community and Recreational Activities Example: day programs, sport, recreational, community activities- Karate, soccer

Family and Informal Support Systems

EXAMPLE: lives with family/group home, extended family, friends, groups, excellent attachment and

support from family, Informal support systems YES/NO (friendships unstable unreliable), difficulties

interpreting others' behaviour and can become confused, Accessing regular and consistent support from

CLINICIANS at Educational Case Management, Other formal supports include GP and SPECIALIST

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Activities of daily living

Independent Dressing Hygiene Communication Financial House cleaning Socialization Academic skills Transport Emergency Cooking/meal management Mobility Physically capable self-care activities of daily living however requires daily list and prompting YES/NO

Requires supervision in the kitchen and bathroom YES/NO

Has difficulties finding the right items of clothing to dress YES/NO

Needs others to assist in preparing for daily activities YES/NO

Dependent / prompting require Dressing Hygiene Communication Financial House cleaning Socialization Academic skills Transport Emergency Cooking/meal management Mobility

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Related Mainstream Services Government Non-Government/NGO

• Daily Programs: HWNS, MIDS, SAMARITANS

Support Services Professional Services:

• Psychologist

• Occupational Therapist

• Speech Therapist:

• Specialist:

Treatment Order/Legal order

Legal Responsibility Guardianship

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Behaviour 1: (clinician to complete

Behaviour of concern: example: verbal aggression, physical aggression, eating/food issues, property

damage, harm, refusal, inappropriate behaviours including sexualized

Description: Self-injury – example hitting head; bite hand; removing clothes, grabbing others, pulling hair,

destroy furniture, inappropriate hygiene practices. Easily irritable and upset, and may withdrawal /avoid

which results in a SEVERE breakdown in communication

Frequency/duration: daily, weekly, occasionally, regular

Intensity: Mild/Moderate/Severe

Setting events: Reacting with anxiety or frustration across a range of environments or situations- occurs

mainly home/community/ in care/ shops/school

Triggers: e.g. does not want to do something, does not understand the requirement, confusion, fear,

heightened anxiety/frustration about what is about to happen, high need for sensory input, attempts to

communicate wants/ needs yet unable due to communication difficulties, unable to fully understand what is

happening; noise; too distracting/overwhelming; overheating, feeling guilty.

Low risk scenarios e.g

annoy others

High risk scenarios

e.g Causes bruising

Function of behaviour: self-stimulation, sensory purpose; to communicate frustration, agitation and

anxiety indicates unwell and needs assistance, unwillingness to engage-dislikes circumstances,

Low risk – avoiding escaping request, resulting in consequence – removal of technology

High risk- aggression as a result of heightened levels of frustration and guilt /punishing self

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Setting events: Reacting with anxiety or frustration across a range of environments or situations- occurs

mainly home/community/ in care/ shops/school






annoy others

High risk scenarios

e.g Causes bruising





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Setting events: Reacting with anxiety or frustration across a range of environments or situations- occurs mainly home/community/ in care/ shops/school






annoy others

High risk scenarios

e.g Causes bruising





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annoy others

High risk scenarios

e.g Causes bruising





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annoy others

High risk scenarios

e.g Causes bruising





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Formulation and Hypothesis (clinician to complete)

Formulation and Hypotheses (Clinical reports)

Diagnosis contributing to inappropriate behaviours include.

Autism Spectrum Disorder: 1) social communication and social interaction across multiple contexts, social-

emotional reciprocity, nonverbal communicative behaviours used for social interaction, and in developing,

maintaining, and understanding relationships; 2) restricted, repetitive patterns of behaviour: insistence on

sameness, inflexible adherence to routines, ritualized patterns of verbal or nonverbal behaviour; and highly

restricted, fixated interests that are abnormal in intensity; and 3) significant dislikes and hypersensitivities.

Deficits in social communication:

Language Impairments:

Cognitive functioning: failure to meet developmental and sociocultural standards for personal independence

and social responsibility, difficult to learn new skills and new behaviours, inability to problem solve.

Adaptive functioning:

Neurodevelopmental/executive functioning deficits: poor self-awareness, reduced ability to focus, shift, and

sustain attention, poor impulse control, fidgets, does not respond to consequences, poor processing, difficulty

transitioning between tasks

Environmental Triggers: home, residence. School settings

Anxiety: inability to control anxiety- results in panic. Extreme sensitivity, fearful, family history of mental

health issues

Depression: prolonged period of low mood and energy, feelings of sadness, and isolation, poor resilience,

highly sensitive, internalise thoughts/negativity, lack of motivation, feelings of helplessness, fatigue, flat

affect.

Psychiatric Issue:

Trauma

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Goals for the Plan (clinician to complete)

Specific Goal 1: Better manage emotions: Reduce reactive behaviours and frustration, Develop emotional regulation

skills, Reduce anxiety through daily structures, supportive environments Express emotions effectively, self-

awareness of her emotions, triggers and behaviours.

• Measurable - 2 x 6 month intensive therapy periods, reduce behaviours from 2 x per day to 1 x day

• Achievable: e.g. reinforcing daily so to enhance ability to identify feelings across range of situation

• Relevant: to be able to identify feelings in a particular situation and acknowledge physical sensations associated

with those feeling will enable opportunities to replace those feelings/behaviours of concern with more positive and

supportive thought processes and strategies

• Time-specific: Within 12 months be able to independently engage in an appropriate regulation strategy in response

to triggers and difficult thoughts and feelings.

Specific Goal 2: Enhance confidence and self-esteem, Better manage immature behaviours and poor self-awareness,

Reduce preoccupations with minor issues, reduce the need for prompting

• Measurable-

• Achievable:

• Relevant:

• Time-specific:

• Specific Goal 3: Increase social participation, peer relationships & social skills

• Measurable-

• Achievable:

• Relevant:

• Time-specific:

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Specific Goal 4: Reduce attention seeking behaviour, Improve listening skills, encourage eye contact and

reciprocity

• Measurable-

• Achievable:

• Relevant:

• Time-specific:

Specific Goal 5: Increase Independence and responsibility: (e.g. showering) supported by visual prompts

• Relevant: specific to current functioning

• Time-specific:

• Measurable -

• Achievable:

• Relevant:

• Time-specific:

Specific Goal 6: Reduce specific inappropriate behaviours- Reduce defiance/avoidance, reduce binge

eating/hoarding Improve self-control - food intake and routine

• Measurable-

• Achievable:

• Relevant:

• Time-specific:

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Measures to Assess plan-(clinician to complete)

- Quality of Life Indicators

- Incident /Behaviour Data

- Adaptive Behavioural Assessments- Adaptive Behaviour Assessment Scale (ABAS-3)/Vineland -

determine degree of independence in daily living/self-care tasks and adaptive behaviour

- Attendance data (school/day programs)-avoidance

- Clinical interview -determine impact on quality of life from a person-centred perspective

- Team meetings /Home Visits- multidisciplinary approach to ensuring best practice/evidence based

therapies

- Assessment measures -weekly ABA forms to be completed by all those involved in the

implementation of the BMP -ABC data collection - record incidents of target behaviours and

identify triggers (antecedents) and consequences; determine frequency and intensity of behaviours

1) the provider is provided with monthly reports from stakeholders regarding behavioural strategies being

applied / use of restrictive practices

2) if the use of the regulated restrictive practice is also a reportable incident, Stakeholders report the

incident to the provider in accordance with Part 3 of the National Disability Insurance Scheme

(Incident Management and Reportable Incidents) Rules 2018.

3) written information relating to behavioural strategies and use of the restrictive practices

4) impact of the restricted practice on the client needs

5) A description of the behaviour that lead to the use of the regulated restrictive practice needs to be

noted; a) the actions taken in response to the use of the regulated restrictive practice; b) what other less

restrictive options were considered or used before using the regulated restrictive practice; c) the

actions taken leading up to the use of the regulated restrictive practice, including any strategies used to

prevent the need for the use of the practice. This will allow the Psychologist to make the necessary

adjustments to the BMP when reviewed.

6) The regulated restrictive practice included in this BMP must be used only in accordance with the

behaviour support plan with the provider notifying the specialist behaviour support provider if there

has been a change in circumstances that requires the behaviour support plan to be reviewed earlier

than proposed date.

7) Review of appropriateness of restrictive practices and fade out plan

8) current functional behavioural assessment which will determine and better understand the function or

purpose behind behaviour will require the collection of data, observations, and information to develop

an understanding of the relationship of events and circumstances that trigger and maintain the

behaviour. It will be crucial that the provider provides all information worthy of further discussion to

the Specialist

9) identify behaviours and make the necessary accommodations and adjustments in a timely manner.

10) Ensure develops a sound relationship with all workers/clinicians so to reduce behaviours that are

identified as inappropriate.

11) restrictive practices may need to be rapidly implemented in response to situations where there is a

clear and immediate risk of harm linked to behaviour(s) of concern and there is no behaviour support

plan in place that accommodates for the specific behaviour that occurred. Informing the Behavioural

Support Specialist of the incident immediately and implementing the least intrusive restrictive

practice, long enough so to reduce any potential risk will be necessary. The Behavioural Support

Specialist will then review the current BMP and make the necessary adjustments.

12) use Behaviour Incident Report forms and Scatterplots to record the frequency, duration and intensity

of the behaviour that causes harm to self or others and what occurred immediately prior to and after

the behaviour that causes harm to self or others.

13) Use of replacement behaviours will be recorded on Task Record Sheets.

14) Goal achievement using weekly cumulative graphs on progress in learning the replacement behaviour

across all settings. These will be reported back to Behavioural Therapist.

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Ecological Strategies (clinician to complete)

1) Visual Schedule/Lists - reduce need for verbal prompts-reduce interpersonal tension/conflict

2) Visual timers -prepare for transitions from preferred to non-preferred tasks

3) Activity scheduling - increase engagement with enjoyable/pleasurable and meaningful activities

4) Increase social participation and community engagement

• reduce opportunities - avoidance

• family rules - non negotiable

• give only 2 x options/choices - 5 mins to chose then step in and choses for - once again non

negotiable

• always ensure items in backpack that keeps one occupied when participating in occasions which

triggers anxiety -ipad/phone/fidget toys/music/crossroad puzzles/craft.

• very demanding emotionally - only allow 10mins emotional support 1:1- time frame as will use others

to avoid circumstances which prevents opportunities to develop own strategies. Don't get caught up in

providing excessive reassurance makes behaviour carry on longer

• Complete detective thinking sheet or problem solving sheet from cool kids booklet when resistance

arises

• Use Zones of Regulation - may find it easier identifying a colour to express feelings i.e. blue, yellow,

green and red. Move to teaching self-regulation strategies for each colour- can direct to promote

independence

• Letting avoid things will maintain problem - push to stay at places not comfortable for increasing

amounts of time

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Skill Building (clinician to complete)

Teaching Strategies

Example: benefit from learning some new skills to encourage independence, develop more appropriate

behaviours and develop social skills.

General support

• Teaching or practising key word signs such as ‘no’ and ‘stop’

• encourage use of assertive language /signs /words

• encourage do things on own

• regular praise and positive attention

Relaxation

• Role Model calm breathing when experiencing anxiety -role modelling taking long deep breaths in

through the nose and breathing out through the mouth

Waiting

• supported to understand and tolerate delays / waiting

• introduce timer to assist in waiting

• .build small delays into routine and slowly increase over time

• object symbol or touch cue to be used to communicate wait

• use word ‘wait’ and the touch cue to communicate wait- Wait for approx 5 sec and then say, ‘Ok

• When periods of waiting are longer, introduce diversion activities

Social Skills

• encourage join in activities

• include in activities and provide direct support

• improve skills identifying: nonverbal cues (tone of voice/body language/bullying)

• Upskill in strategies to respond to teasing/bullying including assertive communication skills training.

Emotional regulation

• recognise difficult/uncomfortable emotions

• recognising physiological/somatic cues/early warning signs

• Improve distress tolerance- mindfulness

• replace reactive behaviours with positive thought processes

• use visual reminders- self regulation

• support persons to prompt and redirect.

Cognitive Behaviour Therapy (CBT)

- assist in changing unhealthy/maladaptive patterns of thinking

- complete thought records- link thoughts with feelings and behaviours

- apply ‘Realistic’ thinking skills

- control excessive worry/anxiety that leads to maladaptive thoughts

- Problem-solving skills- enhance adaptive ability to respond

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Skill Building continued (clinician to complete)

a) Provide psychoeducation to increase awareness of signs and symptoms of anxiety

b) Complete an evidence-based anxiety treatment program

c) Learn to identify and express emotions

d) Learn emotion regulation strategies to increase independence regulating emotions

e) Learn to discriminate between tiny, small, medium, big and huge problems and learn to match the size of

reaction to the size of the problem

f) Provide problem-solving skills training to increase flexibility and resilience moving forward when

becomes anxious or upset about something

Anxiety interferes with daily life. Resilience is low and exhibits high levels of emotional distress. Struggles to

communicate to others what is wrong and self-regulate. Can take a long time to recover and is dependent on

others for comfort and support.

‘Cool Kids’ program, which is an evidence-based Cognitive-Behaviour Therapy (CBT) program for anxious

children and their parents. Learn signs and symptoms of anxiety, and the thought processes and behaviour that

maintain anxiety. Learn to use ‘detective thinking’ skills to identify more realistic and adaptive thoughts to

replace rigid and maladaptive thoughts that contribute to negative feeling and rigid maladaptive behaviour. For

program to be effective practice strategies at home between sessions is essential for long-term change in

maladaptive patterns of thoughts, feelings and behaviours.

Great difficulties talking about emotions, often becoming silent and withdrawn rather than communicating to

others what is upsetting. Use of visuals and concepts such as ‘The Zones of Regulation’ -introduce to identify

and expressing emotions to others less confronting e.g. can identify a colour to describe how your feeling or

point to a picture or point on a scale.

Learn to discriminate between tiny, small, medium, big and huge problems to increase ability to put things to

perspective and regulate reaction accordingly. Understand that when reaction is bigger than the size of the

problem, this can make the problem bigger or create new problems.

Learn problem-solving skills (within ‘Cool Kids’). With support identifying the problem, brainstorm possible

solutions and evaluate the likely consequences of each solution. Due to inflexible thinking and behaviour

associate with ASD diagnosis, often gets stuck when things don’t go the desired way and has difficulties

moving on. The aim of teaching problem-solving skills is to build executive functioning skills creating space

for more flexible responses when confronted with a problem.

An important aspect of therapy has also included supporting strategies and how to respond when upset or

anxious. Reduce avoiding situations which triggers anxiety. This will help build confidence and independence

and reduce anxiety in the long-term through gradually confronting feared situations. Supporters to learn to

‘connect then redirect’ (i.e. empathise with how client is feeling before attempting to rationalise and problem-

solve) and to not provide excessive comfort and reassurance when upset, which can inadvertently reinforce the

emotional response and inhibit development of self-regulation due to dependence on a primary attachment

figure.

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Response Strategies (clinician to complete)

Behaviour 1-

Example: Acknowledge feelings and pain with appropriate language, acknowledge demands or perceived

threats, acknowledged inappropriate language and behaviour, listen to the concerns, acknowledge refusal to

carry out non preferred task or challenging task.

Provide with remedies- music, apply visual timer- calming period (count down) if distracted by other tasks -

apply deep breathing, positive psychology, self -soothing device, evidence based therapies-CBT and

mindfulness, support strategies and/or distractions, use senses-awareness of self, prevent being intrusive,

respect personal space, breakdown requests (scaffold) -reduce overload, apply assertive communication skills

in controlling the environment, encourage voicing an opinion and feeling of injustice, offer strategies in

completing tasks methodically, refer to routines and schedules, refer to first than second,

After anxiety is managed -reflect on the process, effectiveness of strategies, complete thought records or mood

diary, refer to distorted thoughts, identify maladaptive patterns of thinking, identify triggers and feeling, refer

to reward chart.

Refer to Behavioural Management Plan and Strategies: interactive visual timetable, highly structured daily

programs, reduce preoccupation and increase daily activity, daily usage of educational and communicative

assistive technology programs to reduce inappropriate and emotionally reactive behaviours, focus on 'Choice'

and self-control-being offered two options only, learn to recognize feelings and distract prior to reaction using

sensory and cognitive stimulating devices, reduce expressive language and instruction, encourage usage of

weighted devices, reduce over stimulation, introduce distractors and filtering with head phones-music or audio

books.

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Regulated Restrictive Practices

As defined by the NDIS Quality and Safeguard Commission

(clinician to complete)

Restrictive practices aim to keep a person safe and protect them from harm - guided by legislation.

Regulated Restrictive Practice MUST be:

• Reported to the NDIS Quality and Safeguard Commission

• Have a comprehensive behaviour support plan developed by NDIS Specialist Behaviour Support

Provider.

• Be Authorised through the FACS Restrictive Authorisation process

Environmental Restraint:which restrict a person’s free access to all parts of their environment,

including items or activities. Example: Locking the fridge or kitchen cupboards to prevent a person

accessing food. Locking front and back doors in a home to prevent a person from leaving the house.

It’s important to remember that even though a Restrictive practice is used to keep a person safe and

protect them.

Circumstances in which the restrictive practice is to be used — include any critical

information otherwise indicate “refer to authorisation document”

Statement of why this restrictive practice is the least restrictive way of ensuring the safety of the person or others

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Description of the anticipated positive and negative effects on the person of using the restrictive practice

Strategies for fading out the use of the restrictive practice — identify a staged plan that outline

how the restrictive practices will be reduced and eventually eliminated over time.

Monitoring and evaluation — what monitoring and data collection procedures will take place

regarding the use of the restrictive practice?

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Mechanical Restraint: mechanical restraint, which is the use of a device to prevent, restrict, or subdue a person’s movement for the primary purpose of influencing a person’s behaviour but does not include the use of devices for therapeutic or non- behavioural purposes. Example: a seat belt buckle is placed on a seat belt to prevent a person taking their seat belt off in the car. A wheelchair table top is put on a wheelchair for the purpose of preventing the person from getting out of their wheelchair.




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Physical Restraint: physical restraint, which is the use or action of physical force to prevent, restrict or subdue movement of a person’s body, or part of their body, for the primary purpose of influencing their behaviour. Physical restraint does not include the use of a hands-on technique in a reflexive way to guide or redirect a person away from potential harm/injury, consistent with what could reasonably be considered the exercise of care towards a person. Example: Physically holding a person’s hands to prevent them from hitting themselves. Using physical force to move a person.




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Seclusion: which is the sole confinement of a person with disability in a room or a physical space at any hour of the day or night where voluntary exit is prevented, or not facilitated, or it is implied that voluntary exit is not permitted. Example: time out in a room/area where the door is shut or the person is not allowed to leave the area.




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Chemical Restraint -PRN- which is the use of medication or chemical substance for the primary

purpose of influencing a person’s behaviour. It does not include the use of medication prescribed by a

medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical

illness or a physical condition. Example: When a person is prescribed a medication that is given every

morning, and the medication is to manage their behaviour or agitation. When a person is given medication

when they become agitates or angry to help them to calm down.




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Medication Details

Medication

Medication

Drug name

Dosage

Unit/measurement

Frequency

Unit of measurement (day, week, month)

Route

Prescriber Name

Date of last review by Doctor

Conditions/limits of use

Side effects

Drug name

Dosage

Unit/measurement

Frequency


Route

Prescriber Name



Side effects

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Chemical Restraint -Routine which is the use of medication or chemical substance for the primary purpose of influencing a person’s behaviour. It does not include the use of medication prescribed by a medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition. Example: When a person is prescribed a medication that is given every morning, and the medication is to manage their behaviour or agitation. When a person is given medication when they become agitates or angry to help them to calm down.




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Medication

Medication

Drug name

Dosage

Unit/measurement

Frequency


Route

Prescriber Name



Side effects

Drug name

Dosage

Unit/measurement

Frequency


Route

Prescriber Name



Side effects

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Medication

Medication

Drug name

Dosage

Unit/measurement

Frequency


Route

Prescriber Name



Side effects

Drug name

Dosage

Unit/measurement

Frequency


Route

Prescriber Name



Side effects

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For assistance with Behaviour Support and/or Restrictive Practices please contact:

Educational Case Management Pty Ltd - Psychology, Speech Pathology and Occupational Therapy

Unit 3, 56 Hudson Street Hamilton 2303 NSW (Psychology and Speech Pathology)

56 Hudson Street Hamilton 2303 NSW (Occupational Therapy and Allied Health Therapist)

Phone: 02 49 698060 Fax: 02 49 692879

Email: [email protected]

Website: www:psychologistnewcastle.com.au

CONFIDENTIALITY NOTICE: The information contained within this email is intended for the addressee

only. The message may contain confidential information, and the wrongful distribution or communication of

such information is prohibited. If you receive this email in error please notify the sender immediately by

reply email and delete the email including any attachments.

CANCELLATION POLICY: If, for some reason you need to cancel or postpone your appointment, please

give the Educational Case Management Pty Ltd at least 24 hours notice, otherwise you may be charged the

cost for the session. Please refer to the Cancellation Policy on our website:

www:psychologistnewcastle.com.au

Feedback, complaints and disputes

If the Participant wishes to give the Provider feedback, the Participant can talk to Lynette

Bainbridge Practice Manager

If the Participant is not happy with the provision of supports and wishes to make a complaint,

the Participant can talk to Lynette Bainbridge (Practice Manager) and/or complete complaints

form.

Participant can contact the National Disability Insurance Agency by calling 1800 800 110

Signature of Participant /Representative: (completing form)

__________________________________________________

Signature of authorised person from Provider (supporting referral):

__________________________________________________

mailto:[email protected]

MY BEHAVIOURAL MANAGEMENT PLAN Name · 1 MY BEHAVIOURAL MANAGEMENT PLAN Name: CODES: BMP –...

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